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Alcohol: Impact and Reduction Pat Jackson, RN National TEAP Consultant Sara Mackenzie, MD, MPH San Francisco Regional Medical Consultant.

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Presentation on theme: "Alcohol: Impact and Reduction Pat Jackson, RN National TEAP Consultant Sara Mackenzie, MD, MPH San Francisco Regional Medical Consultant."— Presentation transcript:

1 Alcohol: Impact and Reduction Pat Jackson, RN National TEAP Consultant Sara Mackenzie, MD, MPH San Francisco Regional Medical Consultant

2 Understanding Alcohol Risks on Center Describe relationship of alcohol use to employability Identify drinking patterns and risks associated with alcohol use among youth Review screening and intervention options Practice brief clinical intervention 2

3 Issues Reporting inaccurate Alcohol-related issues not recognized Alcohol related issues not reported All of this is why we are here 3

4 Alcohol Statistics WHY ARE WE HERE?

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6 What percentage of industrial injuries are linked to alcohol use? 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 47% Source: Workers Compensation News Network

7 What percentage of heavy alcohol users hold down a job? 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 74% Source: National Drug Free Workplace Alliance

8 What percentage of adults who are employed full time drink alcohol? 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 63% Source: National Survey on Drug Use and Health 2007, SAMHSA

9 Job Corps Statistics Alcohol separations for six months ending February 28, 2009 numbered 167. This is less than one percent of the total separations. During the last program year, 70.5% of the students tested for alcohol use were positive. 9

10 Job Corps Statistics There were 288 significant incidents in the last program year that were reported as related to alcohol. 10

11 Alcohol Use among High School Youth Most widely used substance by youth (12th grade students in U.S.) –44.4% report use of alcohol in past 30 days –21.9% report use of any illicit drug –18.8 % report use of marijuana 28.7% of 12th graders report being drunk Source: Monitoring the future. National results on adolescent drug use Overview of key findings

12 Trends Over Past 30 Years 12

13 Trends Over Past 30 Years 13

14 Subgroup Differences for Alcohol Males generally have higher rates of heavy drinking than females Students who are not college bound have higher rates of drinking heavily South and west generally lower rates of drinking Rates of binge drinking roughly equivalent among socioeconomic levels Whites>Hispanics>African Americans 14

15 Young Adults in Primary Care *Grossberg PM, Brown D, Fleming M. Ann Fam Med. 2004:2; year olds, Wisconsin primary care patients, n=2,460 15

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18 Negative Results of Alcohol Use Educational difficulties Psychosocial problems Physical harm –Overdose –Injury –Sexual high risk behavior –Alcohol impaired driving 18

19 Role of Alcohol in U.S. Violent Deaths 50,000 die annually from violence related injury in U.S. Data from 16 states: –55.9% suicide –28.2% homicide –15.1% undetermined intent –0.7% unintentional firearm Source: MMWR Surveillance for Violent Deaths. Nat’l Violent Death Reporting System. 16 States, March 20, (SS01);

20 Death from Violence-Related Injury Of the 76% of decedents tested –32% positive for alcohol –24.5% positive for opiates –15.6% positive cocaine –11.9% positive marijuana –4.7% positive amphetamines Source: MMWR Surveillance for Violent Deaths. Nat’l Violent Death Reporting System. 16 States, March 20, (SS01);

21 College Health Intervention Projects (CHIPs) 21

22 CHIPs Preliminary Data 22

23 Opportunities to Change? Every student’s contact with faculty or staff for academics, advising, housing, student affairs, counseling, or clinical interactions is an opportunity to elicit a prevention “motivational moment” Brief, student-focused, related to current concern and designed to stimulate specific effort toward behavior change 23

24 Screening on Admission Form: 24

25 Opportunities to Screen On admission At medication checks At acute visits At follow up visits After “incidents” 25

26 Different Drinking Levels At-risk drinking –Men: greater than 4 drinks per occasion or 14 drinks per week –Women: greater than 3 drinks per occasion or 7 drinks per week Alcohol abuse Alcohol addiction 26

27 CAGE Screen-Test for Alcohol Dependence Have you ever felt you should cut down on your drinking? Have people annoyed you by criticizing your drinking? Have you ever felt bad or guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? 27

28 Specialized Treatment Primary Prevention Brief Intervention None Mild Moderate Severe Thresholds for Action Spectrum of Intervention Response 28

29 Brief Alcohol Interventions Cochrane Collaboration Multiple studies of different interventions show efficacy of brief interventions in primary care settings All utilize screening, feedback on alcohol use and harms, identification of high risk situations, increase motivation and development of plan to reduce 5-15 minutes at 1 to 4 visits Source: Effectiveness of brief alcohol interventions in primary care populations. Kaner ER, Dickinson HO, Beyer FR et al. Cochrane Data base of Systematic Reviews 2007 Issue 2 29

30 Brief Clinical Intervention 30

31 Screening Moments At med checks? –Zoloft, paxil, prozac, lexapro, celexa –Adderall, ritalin –Antihypertensives –Non-steroidal medications –Tylenol –Dilantin –Narcotics… 31

32 Brief Screening for Alcohol Use Frequency –“How many days per week do you drink alcohol?” Quantity –“How many drinks will you have when you drink?” Binge drinking –“How many times per month will you drink more than (4 or 5) drinks on a single occasion?” –“Do you ever drink to the point of being drunk?” Fleming, M.F., & Graham, A.W. (2001); "Screening and Brief Interventions for Alcohol Use Disorders in Managed Care Settings;" Recent Developments in Alcohol, 15, National Institute on Alcohol Abuse and Alcoholism (1995); The Physicians' Guide to Helping Patients with Alcohol Problems. (DHHS NIH Pub No ), Washington, DC: U.S. Government Printing Office.. 32

33 Ask likes and dislikes What do you like about alcohol? –The buzz, relaxing, fun –Taste –Being with friends, social… What do you dislike about alcohol? –Hangovers, passing out –Cost –Calories… 33

34 Social Norms Do you drink more or less than people your age? 34

35 Drinking Consequences People often report the following things have happened while drinking, have any of the following happened to you? –Did something they regret –Drove after drinking –Had an injury –Memory loss/black out –Argued with friends –Had unplanned sex –Fell behind in school or work 35

36 Goals and Plans What are you hoping to accomplish in the next 3 months? 6 months? Year? Will drinking at your current level make that easier? Harder? No different? Develop discrepancy 36

37 Express Concern I am concerned about your level of drinking because… 37

38 Principles of Motivational Interviewing Roll with resistance –Reflect, reframe, redirect Express empathy –Reflective listening Avoid argumentation –Or direct confrontation Develop discrepancy –Between goals and behavior Support self-efficacy –Optimism, ability to make changes 38

39 Readiness to Change 39

40 Make a Plan It sounds like you might be ready to make some changes. What would you like to do? –Reduce number of drinks per occasion –Reduce number of days drinking –Not drive after drinking –Avoid hard liquor 40

41 Follow Up Why don’t we check in next week when you come to pick up your medications… Let’s make an appointment in 2 weeks for follow up of your blood pressure… ??? 41

42 Practice Session Screening questions Ask likes and dislikes Social norms Drinking consequences Goals and plans Express concern Assess readiness to change Make a plan Follow up 42

43 All educational events must meet the following standards: Training content must be current and designed to include recent developments. –NAADAC


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